José Corrêa Lima Netto

Tratamento cirúrgico de crianças com pneumonia necrosante

OBJECTIVE To describe the results of the surgical treatment of children with necrotizing pneumonia. METHODS A retrospective analysis of the medical charts of 20 children diagnosed with necrotizing pneumonia and submitted to surgical treatment between March of 1997 and September of 2008 in the thoracic surgery departments of two hospitals in the city of Manaus, Brazil. We compiled data regarding age, gender, etiologic agent, indications for surgery, type of surgical resection performed, and postoperative complications. RESULTS The mean age of the patients was 30 months. Of the 20 patients studied, 12 (60%) were female. The most common etiologic agents were Staphylococcus aureus, in 5 patients (25%), and Klebsiella sp., in 2 (10%). The indications for surgery were sepsis, in 16 patients (80%), and bronchopleural fistula, in 4 (20%). The types of surgical procedures performed were lobectomy, in 12 patients (60%), segmentectomy, in 7 (35%), and bilobectomy, in 1 (5%). There were 8 patients (40%) who also underwent decortication. The postoperative complications were as follows: bronchopleural fistula, in 4 patients (20%); empyema, in 1 (5%); pneumatocele, in 1 (5%); and phlebitis of the left arm, in 1 (5%). Four (20%) of the patients died. CONCLUSIONS Surgical resection should be considered in patients with evidence of pulmonary necrosis. Resection is indicated in cases of severe sepsis, high output bronchopleural fistula, or acute respiratory failure that are refractory to clinical treatment.

Doença de Castleman associada a sarcoma de células dendríticas foliculares e miastenia gravis

Castlemans disease is an atypical lymphoproliferative disorder of unknown etiology, which might be associated with various clinical conditions, including autoimmune diseases and malignant neoplasms. We report the case of a 72-year-old female patient who was referred to the thoracic surgery department of Getulio Vargas University Hospital, in the city of Manaus, Brazil, for the resection of a posterior mediastinal tumor. Three months prior, the patient had been admitted to the ICU with signs of severe dyspnea, at which time she was diagnosed with myasthenia gravis. After the resection of the mediastinal tumor, the histopathological examination revealed hyaline vascular-type Castlemans disease, complicated by follicular dendritic cell sarcoma. At this writing, the patient was being treated with an anticholinesterase agent and corticosteroids for the control of myasthenia gravis.

Trauma torácico: análise de 124 pacientes submetidos à toracotomia

OBJECTIVE To analyze patients who underwent thoracotomy for the treatment of chest trauma in the City of Manaus. METHODS We performed a retrospective study through analyzed records in the two main reference hospitals for trauma adults in this city during a period of 5 years. We considered for this study the epidemiological data, causal agent, type of incision, anatomical classification score of trauma, prognostic factors and mortality. RESULTS We analyzed 124 patients who underwent thoracotomy with a mean age of 28 years. Stab wounds were the most common casual agent (68%). The main indication for thoracotomy was massive hemothorax with 50.7% of cases, followed by cardiogenic or hypovolemic shock with 48.4%. There were 28 deaths (20.6%). Patients with vena cava injuries (5 patients) and aorta lesions (2 patients) had 100% mortality rate. There was a higher mortality in patients with major index of trauma (p = 0004), and largest quantity of blood transfused (p = 0090). CONCLUSION Thoracic trauma patients submitted to exploratory thoracotomy were young, males and victims of stab wound trauma. The most contributing death factors were the lethal anatomical score, more than 15 points, and the association with major vascular lesions, as the aorta and vena cava.

Skin Depigmentation: Could it Be a Complication Caused by Thoracic Sympathectomy?

Primary hyperhidrosis is an idiopathic disorder, and its definitive treatment is obtained through thoracic sympathectomy. However, this procedure is not exempt from complications and compensatory sweating is the main inconvenience described. In this article, 2 patients were submitted to video-assisted thoracoscopic sympathectomy, and after approximately 8 months they noticed depigmentation of the region corresponding to the blockage of sympathetic stimulus. This fact could be explained by the possible effect of the nervous system on the melanocytes of human skin. Thus, patients with primary hyperhidrosis, who are candidates for thoracic sympathectomy and have brown skin, must be made aware of this possible complication.

Tumor carcinoide e sequestro pulmonar

Pulmonary sequestration is defined as a mass of lung tissue separated from the tracheobronchial tree and irrigated by an anomalous systemic artery. It is rarely seen in conjunction with lung neoplasms. We report the case of a 39-year-old female patient diagnosed with a carcinoid tumor, located in the intermediate bronchus and accompanied by bronchiectasis in the right lower lobe. The patient underwent thoracotomy for the resection of the affected area. During surgery, she presented with significant hemorrhage resulting from the transection of the anomalous artery that irrigated an intralobar pulmonary sequestration, which was located in right lower lobe and had not been identified in pre-operative examinations.

Chest wall reconstruction with titanium plates after desmoid tumor resection.

A reconstrucao da parede toracica se torna necessaria quando ha defeitos de parede com diâmetro maior que 5 cm que comprometam a dinâmica respiratoria. Seu objetivo e restaurar a integridade da parede, assim como manter a impermeabilizacao pleural, o padrao estetico do contorno do torax e a dinâmica respiratoria. Alem disso, objetiva-se proteger os orgaos vitais intratoracicos, evitando a herniacao pulmonar e a respiracao paradoxal e preservando a complacencia pulmonar.